Intravascular delivery of nanoparticle compositions and uses thereof

ABSTRACT

The present invention provides methods of delivering a composition comprising nanoparticles that comprise a macrolide and an albumin by directly injecting the nanoparticle composition into the blood vessel wall or the tissue surrounding the blood vessel wall. The methods can be used for inhibiting negative remodeling or vascular fibrosis in the blood vessel and are useful for treating various diseases.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/714,131, filed May 15, 2015, which is a continuation of U.S. patentapplication Ser. No. 14/113,568 (U.S. Pat. No. 9,061,014), which adoptsthe international filing date of Apr. 27, 2012, which is a NationalPhase application under 35 U.S.C. § 371 of International Application No.PCT/US12/35626, filed Apr. 27, 2012, which claims priority benefit ofU.S. Provisional Application Ser. No. 61/518,084, filed Apr. 28, 2011and U.S. Provisional Application Ser. No. 61/557,851, filed Nov. 9,2011, the contents of each are hereby incorporated herein by referencein their entirety.

TECHNICAL FIELD

The present invention relates to methods of delivering and use of acomposition comprising nanoparticles that comprise a macrolide and analbumin by directly injecting the nanoparticle composition into theblood vessel wall or the tissue surrounding the blood vessel wall.

BACKGROUND

Coronary artery disease is one of the leading causes of death throughoutthe world. While coronary artery bypass surgery is an effectivetreatment for stenosed arteries resulting from atherosclerosis and othercauses, it is a highly invasive procedure and requires substantialhospital and recovery time. Percutaneous transluminal coronaryangioplasty (PTCA), commonly referred to as balloon angioplasty, is lessinvasive, less traumatic, and significantly less expensive than bypasssurgery. The effectiveness of balloon angioplasty has improvedsignificantly with the introduction of stenting which involves theplacement of a scaffold structure within the artery which has beentreated by balloon angioplasty. The stent inhibits abrupt reclosure ofthe artery and has some benefit in reducing subsequent restenosisresulting from hyperplasia. Despite such improvement, patients who haveundergone angioplasty procedures with subsequent stenting still sufferfrom a high incidence of restenosis resulting from hyperplasia.Implanting of stents which have been coated with anti-proliferativedrugs can significantly reduce the occurrence of hyperplasia.

Albumin-based nanoparticle compositions have been developed as a drugdelivery system for delivering substantially water insoluble drugs suchas a taxanes. See, for example, U.S. Pat. Nos. 5,916,596; 6,506,405;6,749,868, and 6,537,579, 7,820,788, and 7,923,536. It is generallybelieved that the albumin-based nanoparticle, such as Abraxane®, whenintroduced into the blood stream, would dissolve into albumin-drugcomplexes. Such complexes utilize the natural properties of the proteinalbumin to transport and deliver substantially water insoluble drugs tothe site of disease, such as tumor sites. In addition, the albumin-basednanoparticle technology offers the ability to improve a drug'ssolubility by avoiding the need for toxic chemicals, such as solvents,in the administration process, thus potentially improving safety throughthe elimination of solvent-related side effects.

The disclosures of all publications, patents, patent applications andpublished patent applications referred to herein are hereby incorporatedherein by reference in their entirety.

BRIEF SUMMARY OF THE INVENTION

The present application in some embodiment provides a method ofdelivering a composition comprising nanoparticles comprising albumin anda macrolide to a blood vessel, wherein the method comprises injectinginto the blood vessel wall or tissue surrounding the blood vessel wallan effective amount of a composition comprising nanoparticles comprisinga macrolide and an albumin. In some embodiments, there is provided amethod of inhibiting negative remodeling in a blood vessel in anindividual in need thereof, comprising injecting into the blood vesselwall or tissue surrounding the blood vessel wall an effective amount ofa composition comprising nanoparticles comprising a macrolide and analbumin. In some embodiments, there is provided a method of inhibitingvascular fibrosis (such as medial fibrosis or adventitia fibrosis) in ablood vessel in an individual in need thereof, comprising injecting intothe blood vessel wall or tissue surrounding the blood vessel wall aneffective amount of a composition comprising nanoparticles comprising amacrolide and an albumin. In some embodiments, there is provided amethod of reducing proliferation index in a blood vessel in anindividual in need thereof, comprising injecting into the blood vesselwall or tissue surrounding the blood vessel wall an effective amount ofa composition comprising nanoparticles comprising a macrolide and analbumin. In some embodiments, there is provided a method of promotingpositive remodeling in a blood vessel in an individual in need thereof,comprising injecting into the blood vessel wall or tissue surroundingthe blood vessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide and an albumin.

In some embodiments, the blood vessel is an artery, such as a coronaryartery or a peripheral artery. In some embodiments, the artery isselected from the group consisting of renal artery, cerebral artery,pulmonary artery, and artery in the leg. In some embodiments, the bloodvessel is a vein.

In some embodiments, the nanoparticle composition is injected into theblood vessel wall. In some embodiments, the nanoparticle composition isinjected into the tissue surrounding the blood vessel wall. In someembodiments, the nanoparticle composition is injected into theadventitial tissue of the blood vessel.

In some embodiments, the nanoparticle composition is injected at a doseof about 0.001 mg to about 100 mg, including for example about 0.05 mgto about 5 mg. In some embodiments, the injection volume of thenanoparticle composition is about 0.01 ml to about 50 ml, including forexample, about 0.5 ml to about 5 ml. In some embodiments, thenanoparticle composition is injected though a catheter with a needle,such as a deployable needle. In some embodiments, the nanoparticlecomposition is injected at least once a year. In some embodiments, thenanoparticle composition is injected only once.

In some embodiments, the nanoparticle composition is injected distal tothe disease site. In some embodiments, the nanoparticle composition isinjected proximal to the disease site. In some embodiments, thenanoparticle composition is injected at or adjacent to the disease site.In some embodiments, the nanoparticle composition is injected remotelyfrom the disease site. In some embodiments, the nanoparticle compositionis injected at least about 2 cm (including for example at least any of3, 4, 5, 6, 7, 8, 9, or 10 cm) away from the disease site.

In some embodiment according to any of the above embodiments, theindividual has any one of: angina, myocardial infarction, congestiveheart failure, cardiac arrhythmia, peripheral artery disease,claudication, or chronic limb ischemia. In some embodiments, theindividual is a human. In some embodiments, the method is carried outduring vascular interventional procedure, including but not limited to,angioplasty (such as percutaneous translumenal coronary angioplasty),stenting, or atherectomy. In some embodiments, the method is carried outafter a vascular interventional procedure, including but not limited to,angioplasty, stenting, or atherectomy.

In some embodiments according to any of the above embodiments, themacrolide is rapamycin or a derivative thereof. In some embodiments, themacrolide is rapamycin. In some embodiments according to any of theabove embodiments, the nanoparticles in the composition have an averagediameter of no greater than about 200 nm, such as no greater than about100 nm. In some embodiments, the nanoparticles in the composition havean average diameter of no less than about 70 nm. In some embodiments,the macrolide in the nanoparticles is coated with albumin.

Also provided are kits and devices for use in any of the methodsdescribed herein. For example, in some embodiments, there is provided acatheter with a needle (such as a deployable needle), wherein the needlecontains a composition comprising nanoparticles comprising a macrolideand an albumin. In some embodiments, the macrolide is rapamycin. In someembodiments, the nanoparticles comprise a macrolide coated with albumin.In some embodiments, the nanoparticles in the composition have anaverage diameter of no greater than about 200 nm, such as no greaterthan about 100 nm. In some embodiments, the nanoparticles in thecomposition have an average diameter of no less than about 70 nm.

These and other aspects and advantages of the present invention willbecome apparent from the subsequent detailed description and theappended claims. It is to be understood that one, some, or all of theproperties of the various embodiments described herein may be combinedto form other embodiments of the present invention.

BRIEF DESCRIPTION OF FIGURES

FIGS. 1A and 1B provide images of the micro-infusion catheter utilizedfor periadventitial injection of Nab-rapamycin in the femoral artery.FIG. 1A shows a deflated balloon which sheathes the needle. FIG. 1Bshows an inflated balloon with the needle extruding outward.

FIGS. 2A and 2B provide two flow charts for the study design involvingperiadventitial injection of Nab-rapamycin in a porcine femoral arteryballoon angioplasty injury model. FIG. 2A shows a flow chart forpharmacokinetics studies. FIG. 2B shows a flow chart for histopathologystudies.

FIGS. 3A, 3B, 3C, 3D, 3E, and 3F show a representative angiogram seriesfor periadventitial injection of Nab-rapamycin in the femoral artery.

FIGS. 4A, 4B, 4C, and 4D show reduction of luminal stenosis afterperiadventitial delivery of Nab-rapamycin as measured by mean lumencross-sectional area (FIG. 4A), mean artery cross sectional area (FIG.4B), mean percent luminal stenosis (FIG. 4C), and average medialfibrosis (FIG. 4D).

FIGS. 5A and 5B show the pharmacokinetics of Nab-rapamycin afterperiadventitial delivery in femoral arteries as measured by serumrapamycin concentration (FIG. 5A) and tissue rapamycin concentration(FIG. 5B).

FIGS. 6A, 6B, 6C, and 6D show histopathology staining of femoralarteries treated with vehicle (FIGS. 6C and 6D) or with Nab-rapamycin(FIGS. 6A and 6B) by periadventitial delivery. FIGS. 6A and 6C showstaining with H&E. FIGS. 6B and 6D show staining with trichrome.

FIG. 7A shows the proliferative index after periadventitial delivery ofNab-rapamycin or a control. FIG. 7B shows the endothelialization afterperiadventitial delivery of Nab-rapamycin or a control.

FIG. 8A shows the proliferative index after periadventitial delivery ofNab-rapamycin at days 3, 8, and 28. FIG. 8B shows the endothelializationafter periadventitial delivery of Nab-rapamycin at days 3, 8, and 28.

FIG. 9A shows adventitial leukocyte infiltration after periadventitialdelivery of Nab-rapamycin or a control at days 3, 8, and 28. FIG. 9Bshows mean number of adventitial vessels after periadventitial deliveryof Nab-rapamycin or a control at day 28.

FIG. 10 shows re-endothelialization of target arteries afterperiadventitial delivery of Nab-rapamycin or a control at days 3, 8, and28.

DETAILED DESCRIPTION OF THE INVENTION

The present application provides methods of delivering a compositioncomprising nanoparticles comprising a macrolide and an albumin (the“nanoparticle composition”) to a blood vessel, wherein the methodcomprises injecting into the blood vessel wall or tissue surrounding theblood vessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide and an albumin. Such method can beuseful, for example, for inhibiting negative remodeling in the bloodvessel and/or inhibiting vascular fibrosis in the blood vessel, and arethus useful for treating various diseases associated with negativeremodeling and/or vascular fibrosis.

Using a porcine femoral artery balloon injury model, it was shown that ananoparticle composition comprising a macrolide and an albumin, namely,Nanoparticle Albumin-Bound (Nab) Rapamycin (Nab-Rapamycin), wheninjected into the periadventitial tissue of a blood vessel,significantly decreased negative remodeling of the balloon-injured bloodvessel and medial fibrosis in the blood vessel. Within one hour afterthe injection, the rapamycin level in the perivascular tissue was about1500 times higher than that in the blood within an hour, and rapamycinwas retained in the perivascular tissue for at least 8 days.Periadventitial injection of a nanoparticle composition therefore can bean effective method for inhibiting negative remodeling, inhibitingvascular fibrosis, as well as for treating various diseases associatedwith negative remodeling and/or vascular fibrosis.

Thus, the present application in one aspect provides a method ofinhibiting negative remodeling or vascular fibrosis in the blood vesselof an individual in need thereof, comprising injecting into the bloodvessel wall or tissue surrounding the blood vessel wall an effectiveamount of a composition comprising nanoparticles comprising a macrolideand an albumin.

In another aspect, there is provided a method of delivering acomposition comprising nanoparticles comprising a macrolide and analbumin to a blood vessel, wherein the method comprises injecting intothe blood vessel wall or tissue surrounding the blood vessel wall aneffective amount of a composition comprising nanoparticles comprising amacrolide and an albumin.

Further provided are kits and devices (such as a catheter with a needle)that are useful for the methods described herein.

Definitions

The term “individual” refers to a mammal and includes, but is notlimited to, human, bovine, horse, feline, canine, rodent, or primate.

It is understood that aspect and embodiments of the invention describedherein include “consisting” and/or “consisting essentially of” aspectsand embodiments.

Reference to “about” a value or parameter herein includes (anddescribes) variations that are directed to that value or parameter perse. For example, description referring to “about X” includes descriptionof “X”.

As used herein and in the appended claims, the singular forms “a,” “or,”and “the” include plural referents unless the context clearly dictatesotherwise.

Methods of the Present Invention

The present application in some embodiments provides a method ofdelivering a composition comprising nanoparticles comprising albumin anda macrolide (such as rapamycin or a derivative thereof, for examplerapamycin) to a blood vessel, wherein the method comprises injectinginto the blood vessel wall or tissue surrounding the blood vessel wallan effective amount of a composition comprising nanoparticles comprisinga macrolide and an albumin. In some embodiments, there is provided amethod of delivering a composition comprising nanoparticles comprisingalbumin and a macrolide (such as rapamycin) to a blood vessel, whereinthe method comprises injecting into the blood vessel wall or tissuesurrounding the blood vessel wall an effective amount of a compositioncomprising nanoparticles comprising a macrolide and an albumin (such ashuman serum albumin), wherein the macrolide in the nanoparticles iscoated with the albumin. In some embodiments, there is provided a methodof delivering a composition comprising nanoparticles comprising albuminand a macrolide (such as rapamycin) to a blood vessel, wherein themethod comprises injecting into the blood vessel wall or tissuesurrounding the blood vessel wall an effective amount of a compositioncomprising nanoparticles comprising a macrolide and an albumin (such ashuman serum albumin), wherein the average particle size of thenanoparticles in the composition is no greater than about 200 nm (suchas less than about 200 nm, for example no greater than about 100 nm). Insome embodiments, there is provided a method of delivering a compositioncomprising nanoparticles comprising albumin and a macrolide (such asrapamycin) to a blood vessel, wherein the method comprises injectinginto the blood vessel wall or tissue surrounding the blood vessel wallan effective amount of a composition comprising nanoparticles comprisingrapamycin and an albumin (such as human serum albumin), wherein therapamycin in the nanoparticles is coated with the albumin, and whereinthe average particle size of the nanoparticles in the composition is nogreater than about 200 nm (such as less than about 200 nm for example nogreater than about 100 nm). In some embodiments, there is provided amethod of delivering Nab-rapamycin to a blood vessel, wherein the methodcomprises injecting into the blood vessel wall or tissue surrounding theblood vessel wall an effective amount of Nab-rapamycin. In someembodiments, the nanoparticle composition is injected at or adjacent toa disease site (or lesion site), such as no more than about 2, 1, or 0.5cm away from the disease site (or lesion site). In some embodiments, thenanoparticle composition is injected remotely from a disease site (suchexample at least about any of 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 cm awayfrom the disease site).

A typical blood vessel wall has an endothelium which is the layer of thewall which is exposed to the blood vessel lumen. Underlying theendothelium is the basement membrane which in turn is surrounded by theintima. The intima, in turn, is surrounded by the internal elasticlamina over which is located the media. In turn, the media is covered bythe external elastic lamina which acts as the outer barrier separatingthe blood vessel wall from the adventitial tissue, which surrounds theblood vessel wall. The methods described herein include injection of thenanoparticle composition into any one of these layers of the bloodvessel wall. In some embodiments, the nanoparticle composition isinjected into the endothelium. In some embodiments, the nanoparticlecomposition is injected into the basement membrane. In some embodiments,the nanoparticle composition is injected into the intima. In someembodiments, the nanoparticle composition is injected into the internalelastic lamina. In some embodiments, the nanoparticle is injected intothe media. In some embodiments, the nanoparticle is injected into theexternal elastic lamina. In some embodiments, the nanoparticlecomposition is injected into any one of the following regions of a bloodvessel: tunica intima (contains endothelium, basement membrane, internalelastic lamina), tunica media (contains smooth muscle cells), and tunicaadventitia (contains external elastic membrane, collagen fibres).

“Tissue surrounding the blood vessel wall,” used herein interchangeablywith the terms “perivascular” or “periadventitial,” refers to the regionover the outer surface of the blood vessel wall. This includes theadventitial tissue of the blood vessel, as well as regions beyond theadventitial tissue. By controlling the site of the injection of thenanoparticle compositions, the nanoparticle composition can be injectedto the specific desired locations.

Methods and devices have been developed for the purpose of injectingtherapeutic agents into the blood vessel wall and tissues surroundingthe blood vessel wall. For example, catheters carrying needles capableof delivering therapeutic and other agents deep into the adventitiallayer surrounding blood vessel lumens have been described in U.S. Pat.Nos. 6,547,303, 6,860,867 and U.S. Patent Application Publication Nos.2007/0106257, 2010/0305546, and 2009/0142306, the content of each ofthese are specifically incorporated herein by reference in theirentirety. The methods of the present invention in some embodiments use acatheter having a needle for the injection of the nanoparticlecomposition. In some embodiments, the needle is deployable. The cathetercan be advanced intravascularly to a target injection site (which may ormay not be a disease region) in a blood vessel. The needle in thecatheter is advanced through the blood vessel wall so that an apertureon the needle is positioned in the desired region (for example theperivascular region), and the nanoparticle compositions can be injectedthrough the aperture of the needled into the desired region.

For example, in some embodiments there is provided a method ofdelivering a composition comprising nanoparticles comprising albumin anda macrolide (such as rapamycin or derivative thereof, for examplerapamycin) to a blood vessel, wherein the method comprises injecting(for example via a catheter with a needle) into the tissue surroundingthe blood vessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide and an albumin. In someembodiments, there is provided a method of delivering a compositioncomprising nanoparticles comprising albumin and a macrolide (such asrapamycin) to a blood vessel, wherein the method comprises injecting(for example via a catheter with a needle) into the tissue surroundingthe blood vessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide and an albumin (such as human serumalbumin), wherein the macrolide in the nanoparticles is coated with thealbumin. In some embodiments, there is provided a method of delivering acomposition comprising nanoparticles comprising albumin and a macrolide(such as rapamycin) to a blood vessel, wherein the method comprisesinjecting (for example via a catheter with a needle) into the tissuesurrounding the blood vessel wall an effective amount of a compositioncomprising nanoparticles comprising a macrolide and an albumin (such ashuman serum albumin), wherein the average particle size of thenanoparticles in the composition is no greater than about 200 nm (suchas less than about 200 nm, for example no greater than about 100 nm). Insome embodiments, there is provided a method of delivering a compositioncomprising nanoparticles comprising albumin and a macrolide (such asrapamycin) to a blood vessel, wherein the method comprises injecting(for example via a catheter with a needle) into the tissue surroundingthe blood vessel wall an effective amount of a composition comprisingnanoparticles comprising rapamycin and an albumin (such as human serumalbumin), wherein the rapamycin in the nanoparticles is coated with thealbumin, and wherein the average particle size of the nanoparticles inthe composition is no greater than about 200 nm (such as less than about200 nm for example no greater than about 100 nm). In some embodiments,there is provided a method of delivering Nab-rapamycin to a bloodvessel, wherein the method comprises injecting (for example via acatheter with a needle) into the tissue surrounding the blood vesselwall an effective amount of Nab-rapamycin. In some embodiments, thenanoparticle composition is injected at a disease site. In someembodiments, the nanoparticle composition is injected distal to adisease site (such example at least about any of 1, 2, 3, 4, 5, 6, 7, 8,9, or 10 cm away from the disease site).

In some embodiments, the nanoparticle composition is injected into theadventitial tissue of the blood vessel. The adventitial tissue is thetissue surrounding the blood vessel, for example the tissue beyond theexternal elastic lamina of an artery or beyond the tunica media of avein. The adventitia has a high concentration of lipid. In someembodiments, the nanoparticle composition is injected into the vasavasorum region of the adventitia. In some embodiments, the nanoparticlecomposition, upon injection, can disperse through the adventitiacircumferentially, longitudinally, and/or transmurally from theinjection site with respect to the axis of the blood vessel from whichthe nanoparticle composition is being injected (herein after referred toas “volumetric distribution”). In some embodiments, the drug (in analbumin-bound form or in nanoparticle form) distributes over a distanceof at least about 1 cm (for example at least about any of 2 cm, 3 cm, 4cm, 5 cm, 6 cm, 7 cm, or more) longitudinally and/or at least 1 cm (forexample at least about any of 2 cm, 3 cm, 4 cm, 5 cm, 6 cm, 7 cm, ormore) radially from the site of injection over a time period no greaterthan 60 minutes. In some embodiments, a concentration of a drug measuredat all locations at least 2 cm from the delivery site is at least 10%(such as at least about any of 20%, 30%, 40%, or 50%) of theconcentration at the delivery site, for example after a period of 60minutes. In some embodiments, the drug (in an albumin-bound form or innanoparticle form) distributes transmurally throughout the endothelialand intimal layers of the blood vessel, the media, and the muscularlayer. While periadventitial administration of pharmaceutical agents haspreviously been reported to allow volumetric distribution of apharmaceutical agent, it was believed larger substances are notefficiently distributed because volumetric distribution was achieved bythe lymphatic microcirculatory system surrounding the blood vessel. Thebehavior of nanoparticle compositions in the adventitial tissue wasunknown. The present invention thus differs from methods previouslyreported in these aspects.

Thus, in some embodiments, there is provided a method of delivering acomposition comprising nanoparticles comprising albumin and a macrolide(such as rapamycin) to a blood vessel, wherein the method comprisesinjecting (for example via a catheter with a needle) into theadventitial tissue of the blood vessel wall an effective amount of acomposition comprising nanoparticles comprising a macrolide and analbumin. In some embodiments, there is provided a method of delivering acomposition comprising nanoparticles comprising albumin and a macrolide(such as rapamycin) to a blood vessel, wherein the method comprisesinjecting (for example via a catheter with a needle) into theadventitial tissue of the blood vessel an effective amount of acomposition comprising nanoparticles comprising a macrolide and analbumin (such as human serum albumin), wherein the macrolide in thenanoparticles is coated with the albumin. In some embodiments, there isprovided a method of delivering a composition comprising nanoparticlescomprising albumin and a macrolide (such as rapamycin) to a bloodvessel, wherein the method comprises injecting (for example via acatheter with a needle) into the adventitial tissue of the blood vesselan effective amount of a composition comprising nanoparticles comprisinga macrolide and an albumin (such as human serum albumin), wherein theaverage particle size of the nanoparticles in the composition is nogreater than about 200 nm (such as less than about 200 nm, for exampleno greater than about 100 nm). In some embodiments, there is provided amethod of delivering a composition comprising nanoparticles comprisingalbumin and a macrolide (such as rapamycin) to a blood vessel, whereinthe method comprises injecting (for example via a catheter with aneedle) into the adventitial tissue of the blood vessel an effectiveamount of a composition comprising nanoparticles comprising rapamycinand an albumin (such as human serum albumin), wherein the rapamycin inthe nanoparticles is coated with the albumin, and wherein the averageparticle size of the nanoparticles in the composition is no greater thanabout 200 nm (such as less than about 200 nm for example no greater thanabout 100 nm). In some embodiments, there is provided a method ofdelivering Nab-rapamycin to a blood vessel, wherein the method comprisesinjecting (for example via a catheter with a needle) into theadventitial tissue of the blood vessel wall an effective amount ofNab-rapamycin. In some embodiments, the nanoparticle composition isinjected at or adjacent to a disease site (such as no more than about 2,1, or 0.5 cm away from the disease site). In some embodiments, thenanoparticle composition is injected remotely from a disease site (suchexample at least about any of 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 cm awayfrom the disease site). In some embodiments, the nanoparticlecomposition, upon injection, achieves a volumetric distribution.

The blood vessel described in some embodiments is an artery, such as acoronary artery or a peripheral artery. In some embodiments, the arteryis selected from the group consisting of renal artery, cerebral artery,pulmonary artery, and artery in the leg. In some embodiments, the bloodvessel is an artery or vein above the knee. In some embodiments, theblood vessel is an artery or vein below the knee. In some embodiments,the blood vessel is a femoral artery. In some embodiments, the bloodvessel is a balloon injured artery.

In some embodiments, the blood vessel is an artery selected from any oneof the following: abdominal aorta, anterior tibial artery, arch ofaorta, arcuate artery, axillary artery, brachial artery, carotid artery,celiac artery, circumflex fibular artery, common hepatic artery, commoniliac artery, deep femoral artery, deep palmar arterial arch, dorsaldigital artery, dorsal metatarsal artery, external carotid artery,external iliac artery, facial artery, femoral artery, inferiormesenteric artery, internal iliac artery, instestinal artery, lateralinferior genicular artery, lateral superior genicular artery, palmardigital artery, peroneal artery, popliteal artery, posterior tibialartery, profunda femoris artery, pulmonary artery, radial artery, renalartery, splenic artery, subclavian artery, superficial palmar arterialarch, superior mesenteric artery, superior ulnar collateral artery, andulnar artery.

In some embodiments, the blood vessel is a vein. In some embodiments,the blood vessel is a vein selected from any one of the following:accessory cephalic vein, axillary vein, basilic vein, brachial vein,cephalic vein, common iliac vein, dorsal digital vein, dorsal metatarsalvein, external iliac vein, facial vein, femoral vein, great saphenousvein, hepatic vein, inferior mesenteric vein, inferior vena cava,intermediate antebrachial vein, internal iliac vein, intestinal vein,jugular vein, lateral circumflex femoral vein, left inferior pulmonaryvein, left superior pulmonary vein, palmar digital vein, portal vein,posterior tibial vein, renal vein, retromanibular vein, saphenous vein,small saphenous vein, splenic vein, subclavian vein, superior mesentericvein, and superior vena cava.

In some embodiments, the blood vessel is part of the coronaryvasculature (including the arterial and venous vasculature), thecerebral vasculature, the hepatic vasculature, the peripheralvasculature, and the vasculature of other organs and tissuecompartments.

In some embodiments, there is provided a method of delivering acomposition comprising nanoparticles comprising albumin and a macrolide(such as a rapamycin or a derivative thereof, for example rapamycin) toa blood vessel, wherein the method comprises injecting (for example viaa catheter with a needle) periadventitially (i.e., injecting into theperiadventitial tissue) to a femoral artery an effective amount of acomposition comprising nanoparticles comprising a macrolide and analbumin. In some embodiments, there is provided a method of delivering acomposition comprising nanoparticles comprising albumin and a macrolide(such as a rapamycin or a derivative thereof, for example rapamycin) toa blood vessel, wherein the method comprises injecting (for example viaa catheter with a needle) periadventitially to a femoral artery aneffective amount of a composition comprising nanoparticles comprising amacrolide and an albumin (such as human serum albumin), wherein themacrolide in the nanoparticles is coated with the albumin. In someembodiments, there is provided a method of delivering a compositioncomprising nanoparticles comprising albumin and a macrolide (such as arapamycin or a derivative thereof, for example rapamycin) to a bloodvessel, wherein the method comprises injecting (for example via acatheter with a needle) periadventitially to a femoral artery aneffective amount of a composition comprising nanoparticles comprising amacrolide and an albumin (such as human serum albumin), wherein theaverage particle size of the nanoparticles in the composition is nogreater than about 200 nm (such as less than about 200 nm, for exampleno greater than about 100 nm). In some embodiments, there is provided amethod of delivering a composition comprising nanoparticles comprisingalbumin and a macrolide (such as a rapamycin or a derivative thereof,for example rapamycin) to a blood vessel, wherein the method comprisesinjecting (for example via a catheter with a needle) periadventitiallyto a femoral artery an effective amount of a composition comprisingnanoparticles comprising rapamycin and an albumin (such as human serumalbumin), wherein the rapamycin in the nanoparticles is coated with thealbumin, and wherein the average particle size of the nanoparticles inthe composition is no greater than about 200 nm (such as less than about200 nm for example no greater than about 100 nm). In some embodiments,there is provided a method of delivering Nab-rapamycin to a bloodvessel, wherein the method comprises injecting (for example via acatheter with a needle) periadventitially to a femoral artery aneffective amount of Nab-rapamycin. In some embodiments, the nanoparticlecomposition is injected at or adjacent to a disease site (such as nomore than about 2, 1, or 0.5 cm away from the disease site). In someembodiments, the nanoparticle composition is injected remotely from adisease site (such example at least about any of 1, 2, 3, 4, 5, 6, 7, 8,9, or 10 cm away from the disease site).

The delivery methods described herein are effective in inhibiting one ormore aspects of blood vessel abnormalities, including for example,negative remodeling, vascular fibrosis, restenosis, cell proliferationand migration of cells in the blood vessel, and wound healing. In someembodiments, the method is effective in promoting positive remodeling ofthe blood vessel.

The present application thus in some embodiments provides a method ofinhibiting negative remodeling in a blood vessel in an individual inneed thereof, comprising injecting into the blood vessel wall or tissuesurrounding the blood vessel wall an effective amount of a compositioncomprising nanoparticles comprising a macrolide (such as rapamycin) andan albumin. In some embodiments, there is provided a method ofinhibiting negative remodeling in a blood vessel in an individual inneed thereof, comprising injecting into the blood vessel wall or tissuesurrounding the blood vessel wall an effective amount of a compositioncomprising nanoparticles comprising a macrolide and an albumin (such ashuman serum albumin), wherein the macrolide in the nanoparticles iscoated with the albumin. In some embodiments, there is provided a methodof inhibiting negative remodeling in a blood vessel in an individual inneed thereof, comprising injecting into the blood vessel wall or tissuesurrounding the blood vessel wall an effective amount of a compositioncomprising nanoparticles comprising a macrolide and an albumin (such ashuman serum albumin), wherein the average particle size of thenanoparticles in the composition is no greater than about 200 nm (suchas less than about 200 nm, for example no greater than about 100 nm). Insome embodiments, there is provided a method of inhibiting negativeremodeling in a blood vessel in an individual in need thereof,comprising injecting into the blood vessel wall or tissue surroundingthe blood vessel wall an effective amount of a composition comprisingnanoparticles comprising rapamycin and an albumin (such as human serumalbumin), wherein the rapamycin in the nanoparticles is coated with thealbumin, and wherein the average particle size of the nanoparticles inthe composition is no greater than about 200 nm (such as less than about200 nm for example no greater than about 100 nm). In some embodiments,there is provide a method of inhibiting negative remodeling in a bloodvessel in an individual in need thereof, comprising injecting into theblood vessel wall or tissue surrounding the blood vessel wall aneffective amount of Nab-rapamycin. In some embodiments, the nanoparticlecomposition is injected at or adjacent to a site of negative remodeling(such as no more than about 2, 1, or 0.5 cm away from the site ofnegative remodeling). In some embodiments, the nanoparticle compositionis injected remotely from a site of negative remodeling (such example atleast about any of 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 cm away from thesite of negative remodeling). In some embodiments, the injection is viaa catheter with a needle.

Negative remodeling includes the physiologic or pathologic response of ablood vessel to a stimulus resulting in a reduction of vessel diameterand lumen diameter. Such a stimulus could be provided by, for example, achange in blood flow or an angioplasty procedure. In some embodiments,the injection of the nanoparticle composition leads to an increase ofvessel diameter by about any of 10%, 20%, 30%, 40%, 60%, 70%, 80%, 95%,or more, compared to the diameter of a vessel of without the injection.Negative remodeling can be quantified, for example, angiographically asthe percent diameter stenosis at the lesion site (or disease site).Another method of determining the degree of remodeling involvesmeasuring in-lesion external elastic lamina area using intravascularultrasound (IVUS). IVUS is a technique that can image the externalelastic lamina as well as the vascular lumen. In some embodiments, thenegative remodeling is associated with a vascular interventionalprocedure, such as angioplasty, stenting, or atherectomy. Thenanoparticle composition can therefore be injected during or after thevascular interventional procedure.

In some embodiments, there is provided a method of promoting positiveremodeling in a blood vessel in an individual in need thereof,comprising injecting into the blood vessel wall or tissue surroundingthe blood vessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide (such as rapamycin) and an albumin.In some embodiments, there is provided a method of promoting positiveremodeling in a blood vessel in an individual in need thereof,comprising injecting into the blood vessel wall or tissue surroundingthe blood vessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide and an albumin (such as human serumalbumin), wherein the macrolide in the nanoparticles is coated with thealbumin. In some embodiments, there is provided a method of promotingpositive remodeling in a blood vessel in an individual in need thereof,comprising injecting into the blood vessel wall or tissue surroundingthe blood vessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide and an albumin (such as human serumalbumin), wherein the average particle size of the nanoparticles in thecomposition is no greater than about 200 nm (such as less than about 200nm, for example no greater than about 100 nm). In some embodiments,there is provided a method of promoting positive remodeling in a bloodvessel in an individual in need thereof, comprising injecting into theblood vessel wall or tissue surrounding the blood vessel wall aneffective amount of a composition comprising nanoparticles comprisingrapamycin and an albumin (such as human serum albumin), wherein therapamycin in the nanoparticles is coated with the albumin, and whereinthe average particle size of the nanoparticles in the composition is nogreater than about 200 nm (such as less than about 200 nm for example nogreater than about 100 nm). In some embodiments, there is provide amethod of promoting positive remodeling in a blood vessel in anindividual in need thereof, comprising injecting into the blood vesselwall or tissue surrounding the blood vessel wall an effective amount ofNab-rapamycin. In some embodiments, the nanoparticle composition isinjected at or adjacent to a site of negative remodeling (such as nomore than about 2, 1, or 0.5 cm away from the site of negativeremodeling). In some embodiments, the nanoparticle composition isinjected remotely from a site of negative remodeling (such example atleast about any of 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 cm away from thesite of negative remodeling). In some embodiments, the injection is viaa catheter with a needle.

Positive remodeling used herein refers to an increase of vessel diameteras compared to the diameter of a vessel without the injection. In someembodiments, the injection of the nanoparticle composition leads to anincrease of vessel diameter by about any of 10%, 20%, 30%, 40%, 60%,70%, 80%, 95%, or more, compared to the diameter of a vessel of withoutthe injection.

In some embodiments, there is provided a method of inhibiting vascularfibrosis (such as medial vascular fibrosis) in a blood vessel in anindividual in need thereof, comprising injecting into the blood vesselwall or tissue surrounding the blood vessel wall an effective amount ofa composition comprising nanoparticles comprising a macrolide (such asrapamycin) and an albumin. In some embodiments, there is provided amethod of inhibiting vascular fibrosis (such as medial vascularfibrosis) in a blood vessel in an individual in need thereof, comprisinginjecting into the blood vessel wall or tissue surrounding the bloodvessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide and an albumin (such as human serumalbumin), wherein the macrolide in the nanoparticles is coated with thealbumin. In some embodiments, there is provided a method of inhibitingvascular fibrosis (such as medial vascular fibrosis) in a blood vesselin an individual in need thereof, comprising injecting into the bloodvessel wall or tissue surrounding the blood vessel wall an effectiveamount of a composition comprising nanoparticles comprising a macrolideand an albumin (such as human serum albumin), wherein the averageparticle size of the nanoparticles in the composition is no greater thanabout 200 nm (such as less than about 200 nm, for example no greaterthan about 100 nm). In some embodiments, there is provided a method ofinhibiting vascular fibrosis (such as medial vascular fibrosis) in ablood vessel in an individual in need thereof, comprising injecting intothe blood vessel wall or tissue surrounding the blood vessel wall aneffective amount of a composition comprising nanoparticles comprisingrapamycin and an albumin (such as human serum albumin), wherein therapamycin in the nanoparticles is coated with the albumin, and whereinthe average particle size of the nanoparticles in the composition is nogreater than about 200 nm (such as less than about 200 nm for example nogreater than about 100 nm). In some embodiments, there is provided amethod of inhibiting vascular fibrosis (such as medial vascularfibrosis) in a blood vessel in an individual in need thereof, comprisinginjecting into the blood vessel wall or tissue surrounding the bloodvessel wall an effective amount of Nab-rapamycin. In some embodiments,the nanoparticle composition is injected at or adjacent to the site ofvascular fibrosis (for example no greater than about any of 2, 1, 0.5 cmaway from the site of vascular fibrosis). In some embodiments, thenanoparticle composition is injected remotely from a site of vascularfibrosis (such example at least about any of 2, 3, 4, 5, 6, 7, 8, 9, or10 cm away from the site of vascular fibrosis). In some embodiments, theinjection is via a catheter with a needle.

Vascular fibrosis as used herein refers to the extensive fibrous(connective) tissue formation in the blood vessel, and includes, forexample, medial fibrosis or adventitial fibrosis. Vascular fibrosis isfrequently associated with abundant deposition of extracellular matrixand proliferation of myofibroblasts and fibroblasts. The methoddescribed herein therefore in some embodiments inhibits fibrous tissueformation in the blood vessel, for example inhibits about any of 10%,20%, 30%, 40%, 50%, 60%, 70%, 80%, or 90% fibrous tissue formationcompared to a vessel without the injection. In some embodiments, themethod inhibits deposition of extracellular matrix in the blood vessel,for example inhibits about any of 10%, 20%, 30%, 40%, 50%, 60%, 70%,80%, or 90% deposition of extracellular matrix compared to a vesselwithout the injection. In some embodiments, the method inhibitsproliferation of myofibroblast in the blood vessel, for example inhibitsabout any of 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, or 90%proliferation of myofibroblast compared to a vessel without theinjection. In some embodiments, the method inhibits proliferation offibroblast in the blood vessel, for example inhibits about any of 10%,20%, 30%, 40%, 50%, 60%, 70%, 80%, or 90% proliferation of fibroblastcompared to a vessel without the injection. In some embodiments, thevascular fibrosis is associated with a vascular interventionalprocedure, such as angioplasty, stenting, or atherectomy. Thenanoparticle composition can therefore be injected during or after thevascular interventional procedure.

The method described herein therefore in some embodiments inhibitsluminal stenosis, for example inhibits about any of 10%, 20%, 30%, 40%,50%, 60%, 70%, 80%, or 90% luminal stenosis compared to a vessel withoutthe injection. In some embodiments, the luminal stenosis is associatedwith a vascular interventional procedure, such as angioplasty, stenting,or atherectomy. The nanoparticle composition can therefore be injectedduring or after the vascular interventional procedure.

In some embodiments, there is provided a method of treating restenosisin a blood vessel in an individual in need thereof, comprising injectinginto the blood vessel wall or tissue surrounding the blood vessel wallan effective amount of a composition comprising nanoparticles comprisinga macrolide (such as rapamycin) and an albumin. In some embodiments,there is provided a method of treating restenosis in a blood vessel inan individual in need thereof, comprising injecting into the bloodvessel wall or tissue surrounding the blood vessel wall an effectiveamount of a composition comprising nanoparticles comprising a macrolideand an albumin (such as human serum albumin), wherein the macrolide inthe nanoparticles is coated with the albumin. In some embodiments, thereis provided a method of treating restenosis in a blood vessel in anindividual in need thereof, comprising injecting into the blood vesselwall or tissue surrounding the blood vessel wall an effective amount ofa composition comprising nanoparticles comprising a macrolide and analbumin (such as human serum albumin), wherein the average particle sizeof the nanoparticles in the composition is no greater than about 200 nm(such as less than about 200 nm, for example no greater than about 100nm). In some embodiments, there is provided a method of treatingrestenosis in a blood vessel in an individual in need thereof,comprising injecting into the blood vessel wall or tissue surroundingthe blood vessel wall an effective amount of a composition comprisingnanoparticles comprising rapamycin and an albumin (such as human serumalbumin), wherein the rapamycin in the nanoparticles is coated with thealbumin, and wherein the average particle size of the nanoparticles inthe composition is no greater than about 200 nm (such as less than about200 nm for example no greater than about 100 nm). In some embodiments,there is provided a method of treating restenosis in a blood vessel inan individual in need thereof, comprising injecting into the bloodvessel wall or tissue surrounding the blood vessel wall an effectiveamount of Nab-rapamycin. In some embodiments, the nanoparticlecomposition is injected at or adjacent to a disease site (for example nomore than about 2, 1, or 0.5 cm away from the disease site). In someembodiments, the nanoparticle composition is injected remotely from adisease site (such example at least about any of 1, 2, 3, 4, 5, 6, 7, 8,9, or 10 cm away from the disease site). In some embodiments, theinjection is via a catheter with a needle.

In some embodiments, there is provided a method of reducing adventitialleukocytes in a blood vessel in an individual in need thereof,comprising injecting into the blood vessel wall or tissue surroundingthe blood vessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide (such as rapamycin) and an albumin.In some embodiments, there is provided a method of reducing adventitialleukocytes in a blood vessel in an individual in need thereof,comprising injecting into the blood vessel wall or tissue surroundingthe blood vessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide and an albumin (such as human serumalbumin), wherein the macrolide in the nanoparticles is coated with thealbumin. In some embodiments, there is provided a method of reducingadventitial leukocytes in a blood vessel in an individual in needthereof, comprising injecting into the blood vessel wall or tissuesurrounding the blood vessel wall an effective amount of a compositioncomprising nanoparticles comprising a macrolide and an albumin (such ashuman serum albumin), wherein the average particle size of thenanoparticles in the composition is no greater than about 200 nm (suchas less than about 200 nm, for example no greater than about 100 nm). Insome embodiments, there is provided a method of reducing adventitialleukocytes in a blood vessel in an individual in need thereof,comprising injecting into the blood vessel wall or tissue surroundingthe blood vessel wall an effective amount of a composition comprisingnanoparticles comprising rapamycin and an albumin (such as human serumalbumin), wherein the rapamycin in the nanoparticles is coated with thealbumin, and wherein the average particle size of the nanoparticles inthe composition is no greater than about 200 nm (such as less than about200 nm for example no greater than about 100 nm). In some embodiments,there is provided a method of reducing adventitial leukocytes in a bloodvessel in an individual in need thereof, comprising injecting into theblood vessel wall or tissue surrounding the blood vessel wall aneffective amount of Nab-rapamycin. In some embodiments, the nanoparticlecomposition is injected into the adventitial tissue.

In some embodiments, there is provided a method of reducing adventitialvessels in a blood vessel in an individual in need thereof, comprisinginjecting into the blood vessel wall or tissue surrounding the bloodvessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide (such as rapamycin) and an albumin.In some embodiments, there is provided a method of reducing adventitialvessels in a blood vessel in an individual in need thereof, comprisinginjecting into the blood vessel wall or tissue surrounding the bloodvessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide and an albumin (such as human serumalbumin), wherein the macrolide in the nanoparticles is coated with thealbumin. In some embodiments, there is provided a method of reducingadventitial vessels in a blood vessel in an individual in need thereof,comprising injecting into the blood vessel wall or tissue surroundingthe blood vessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide and an albumin (such as human serumalbumin), wherein the average particle size of the nanoparticles in thecomposition is no greater than about 200 nm (such as less than about 200nm, for example no greater than about 100 nm). In some embodiments,there is provided a method of reducing adventitial vessels in a bloodvessel in an individual in need thereof, comprising injecting into theblood vessel wall or tissue surrounding the blood vessel wall aneffective amount of a composition comprising nanoparticles comprisingrapamycin and an albumin (such as human serum albumin), wherein therapamycin in the nanoparticles is coated with the albumin, and whereinthe average particle size of the nanoparticles in the composition is nogreater than about 200 nm (such as less than about 200 nm for example nogreater than about 100 nm). In some embodiments, there is provided amethod of reducing adventitial vessels in a blood vessel in anindividual in need thereof, comprising injecting into the blood vesselwall or tissue surrounding the blood vessel wall an effective amount ofNab-rapamycin. In some embodiments, the nanoparticle composition isinjected into the adventitial tissue.

In some embodiments, the individual is human. In some embodiments, theindividual is at least about any of 35, 40, 45, 50, 55, 60, 65, 70, 75,80, or 85 years old. In some embodiments, the individual is of Asianancestry. In some embodiments, the individual is a male. In someembodiments, the individual is a female. In some embodiments, theindividual has a disease as discussed below.

The methods described herein are useful for treating a variety ofdiseases. These include, for example, angina, aortic stenosis,arteriosclerosis obliterans, carotid artery stenosis, cerebrovascularartery disease, cerebrovascular occlusive disease, coronary arterydisease, dilated cardiomyopathy, cardiomyopathy, ischemiccardiomyopathy, intermittent claudication, peripheral artery stenosis,renal artery disease, restenosis, small vessel disease, stenosis, aorticstenosis, Aortic valve stenosis, hyaline arteriolosclerosis,hyperplastic arteriosclerosis, mitrial stenosis, pulmonary valvestenosis, tricuspid valve stenosis, deep vein thrombosis, peripheralvenous disease, and thrombophlebitis. The methods described herein mayencompass the treatment of any one or more of these diseases.

In some embodiments, the disease is selected from the group consistingof angina, myocardial infarction, congestive heart failure, cardiacarrhythmia, peripheral artery disease, claudication, or chronic limbischemia. Thus, for example, in some embodiments, there is provided amethod of treating angina (or myocardial infarction, or congestive heartfailure, or cardiac arrhythmia, or peripheral artery disease, orclaudication, or chronic limb ischemia) in an individual in needthereof, comprising injecting into the blood vessel wall or tissuesurrounding the blood vessel wall an effective amount of a compositioncomprising nanoparticles comprising a macrolide (such as rapamycin) andan albumin. In some embodiments, there is provided a method of treatingangina (or myocardial infarction, or congestive heart failure, orcardiac arrhythmia, or peripheral artery disease, or claudication, orchronic limb ischemia) in an individual in need thereof, comprisinginjecting into the blood vessel wall or tissue surrounding the bloodvessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide and an albumin (such as human serumalbumin), wherein the macrolide in the nanoparticles is coated with thealbumin. In some embodiments, there is provided a method of treatingangina (or myocardial infarction, or congestive heart failure, orcardiac arrhythmia, or peripheral artery disease, or claudication, orchronic limb ischemia) in an individual in need thereof, comprisinginjecting into the blood vessel wall or tissue surrounding the bloodvessel wall an effective amount of a composition comprisingnanoparticles comprising a macrolide and an albumin (such as human serumalbumin), wherein the average particle size of the nanoparticles in thecomposition is no greater than about 200 nm (such as less than about 200nm, for example no greater than about 100 nm). In some embodiments,there is provided a method of treating angina (or myocardial infarction,or congestive heart failure, or cardiac arrhythmia, or peripheral arterydisease, or claudication, or chronic limb ischemia) in an individual inneed thereof, comprising injecting into the blood vessel wall or tissuesurrounding the blood vessel wall an effective amount of a compositioncomprising nanoparticles comprising rapamycin and an albumin (such ashuman serum albumin), wherein the rapamycin in the nanoparticles iscoated with the albumin, and wherein the average particle size of thenanoparticles in the composition is no greater than about 200 nm (suchas less than about 200 nm for example no greater than about 100 nm). Insome embodiments, there is provided a method of treating angina (ormyocardial infarction, or congestive heart failure, or cardiacarrhythmia, or peripheral artery disease, or claudication, or chroniclimb ischemia) in an individual in need thereof, comprising injectinginto the blood vessel wall or tissue surrounding the blood vessel wallan effective amount of Nab-rapamycin. In some embodiments, thenanoparticle composition is injected at or adjacent to a disease site(for example no more than about 2, 1, or 0.5 cm away from the diseasesite). In some embodiments, the nanoparticle composition is injectedremotely from a disease site (such example at least about any of 1, 2,3, 4, 5, 6, 7, 8, 9, or 10 cm away from the disease site). In someembodiments, the injection is via a catheter with a needle. In someembodiments, the nanoparticle composition is injected during or afterthe vascular interventional procedure, such as angioplasty, stenting, oratherectomy.

The methods described herein in some embodiments comprise injecting thenanoparticle composition distal to the disease site. In someembodiments, the nanoparticle composition is injected proximal to thedisease site. The delivery site may be located within the same bloodvessel as the disease treatment region at a location which islongitudinally spaced-apart from the region, or may be located in adifferent blood vessel. In some embodiments, the nanoparticlecomposition is injected at or adjacent to the disease site (for exampleno more than about any of 2, 1, or 0.5 cm away (for examplelongitudinally away) from the disease site). In some embodiments, thenanoparticle composition is injected remotely from the disease site (forexample about any of 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 cm away (forexample longitudinally away) from the disease site). In someembodiments, the disease treatment region may have been previouslystented where the delivery site is spaced away from the stent, eitherlongitudinally away from the stent in the same coronary artery or remotefrom the stent in another coronary artery or vein.

The methods described herein in some embodiments comprise injecting thenanoparticle composition with a needle (such as a deployable needle).The needle can be positioned such that the nanoparticle composition isdelivered to a desired site. The methods in some embodiments thuscomprise positioning a needle through the wall of a blood vessel anddelivering an effective amount of the nanoparticle composition into thewall of the blood vessel or the tissue surrounding the blood vesselwall. For example, in some embodiments, the aperture of the needle liesbeyond the external elastic lamina of the blood vessel so that thenanoparticle composition is delivered to the adventitial tissuesurrounding the blood vessel. In some embodiments, the aperture of theneedle is positioned at a distance that is no more than about 0.1 mm,about 0.2 mm, 0.5 mm, 0.8 mm, 1 cm, 2 cm, 3 cm, 4 cm, 5 cm, 6 cm, 7 cm,or 8 cm beyond the external elastic lamina of the blood vessel.

In some embodiments, the aperture is positioned at a distance from theinner wall of the blood vessel that is at least about 10% (including forexample at least about 20%, 30%, 40%, 60%, 70%, 80%, 90%) of the meanluminal diameter of the blood vessel at the injection site. In someembodiments, the aperture is positioned at a distance from the innerwall of the blood vessel that is about 10% to about 75% (including forexample about 20% to about 60%, about 30% to about 50%) of the meanluminal diameter of the blood vessel at the injection site.

Confirmation of the position of the needle aperture can be achieved in avariety of ways. For example, a bolus of contrast agent or other visiblemedia can be injected through the needle after initial positioning ofthe needle is achieved. By observing the distribution of the media, forexample fluroscopically, the position of the aperture can be assessed.In some embodiments, various sensors can be attached or otherwisecoupled to the needle, usually near the delivery aperture, in order todetect the position of the needle. Exemplary sensors include temperaturesensors, pH sensors, electrical impedance sensors, and the like. It isalso possible to measure the back pressure on an injected suspension inorder to determine the needle position. Injection into the blood vesselwall will typically result in a greater back pressure than injectioninto the adventitial space. It is also possible to monitor the insertionforce of the needle, e.g., by providing a deflection gauge on a portionof the needle.

Dosing and Method of Administering the Nanoparticle Compositions

The dose of the macrolide nanoparticle compositions injected to anindividual (such as a human) may vary with the type of blood vessel forthe injection, the purpose of the method, and the type of disease beingtreated. In some embodiments, the amount of the macrolide nanoparticlecomposition injected is sufficient to inhibit negative remodeling bymore than about any of 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%,55%, 60%, 64%, 65%, 70%, 75%, 80%, 85%, or 90%. Inhibition of negativeremodeling can be assessed, for example, by measuring the vessel orluminal diameter of the blood vessel. In some embodiments, the amount ofthe macrolide nanoparticle composition injected is sufficient to promotepositive remodeling by more than about any of 5%, 10%, 15%, 20%, 25%,30%, 35%, 40%, 45%, 50%, 55%, 60%, 64%, 65%, 70%, 75%, 80%, 85%, or 90%.

In some embodiments, the amount of the macrolide nanoparticlecomposition injected is sufficient to inhibit vascular fibrosis by morethan about any of 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%,60%, 64%, 65%, 70%, 75%, 80%, 85%, or 90%. In some embodiments, thevascular fibrosis is medial fibrosis. In some embodiments, the vascularfibrosis is adventitial fibrosis. Inhibition of vascular fibrosis can beassessed, for example, by evaluating the amount of extracellular matrixdeposition and/or proliferation of myofibroblasts and fibroblasts. Insome embodiments, the vascular fibrosis is evaluated by histopathologyanalysis, for example by staining with H&E or trichrome.

In some embodiments, the amount of the macrolide nanoparticlecomposition injected is sufficient to reduce proliferation index by morethan about any of 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%,60%, 64%, 65%, 70%, 75%, 80%, 85%, or 90%. In some embodiments, theamount of the macrolide nanoparticle composition injected is sufficientto reduce luminal stenosis by more than about any of 5%, 10%, 15%, 20%,25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 64%, 65%, 70%, 75%, 80%, 85%, or90%. In some embodiments, the amount of the macrolide nanoparticlecomposition injected is sufficient to reduce adventitial leukocytes bymore than about any of 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%,55%, 60%, 64%, 65%, 70%, 75%, 80%, 85%, or 90%. In some embodiments, theamount of the macrolide nanoparticle composition injected is sufficientto reduce adventitial vessels by more than about any of 5%, 10%, 15%,20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 64%, 65%, 70%, 75%, 80%,85%, or 90%.

In some embodiments, the amount of the macrolide (e.g., rapamycin) inthe composition is below the level that induces a toxicological effect(i.e., an effect above a clinically acceptable level of toxicity) or isat a level where a potential side effect can be controlled or toleratedwhen the composition is injected to the individual.

In some embodiments, the amount of a macrolide (e.g., rapamycin orderivative thereof, for example rapamycin) per injection is within anyone of the following ranges: about 0.001 to about 100 mg, including forexample about 0.001 to about 0.005 mg, about 0.005 to about 0.025 mg,about 0.025 to about 0.1 mg, about 0.1 to about 0.5 mg, about 0.5 toabout 1 mg, about 1 to about 2 mg, about 2 to about 3 mg, about 3 toabout 4 mg, about 4 to about 5 mg, about 5 to about 6 mg, about 6 toabout 7 mg, about 7 to about 8 mg, about 8 to about 9 mg, about 9 toabout 10 mg, about 10 to about 15 mg, about 15 to about 20 mg, about 20to about 25 mg, about 20 to about 50 mg, about 25 to about 50 mg, about50 to about 75 mg, or about 50 to about 100 mg. In some embodiments, theamount of a macrolide (e.g., rapamycin) per injection is in the range ofabout 0.001 to about 100 mg, such as about 0.005 to about 80 mg, about0.05 to about 50 mg, about 0.1 to about 10 mg, about 0.1 to about 5 mg,about 0.5 to about 5 mg, about 0.05 to about 5 mg, or about 0.5 to about2 mg.

In some embodiments, the concentration of the macrolide (e.g.,rapamycin) in the nanoparticle composition is dilute (about 0.1 mg/ml)or concentrated (about 100 mg/ml), including for example any of about0.1 to about 50 mg/ml, about 0.1 to about 20 mg/ml, about 1 to about 10mg/ml, about 2 mg/ml to about 8 mg/ml, about 4 to about 6 mg/ml, orabout 5 mg/ml. In some embodiments, the concentration of the macrolide(e.g., rapamycin) is at least about any of 0.5 mg/ml, 1.3 mg/ml, 1.5mg/ml, 2 mg/ml, 3 mg/ml, 4 mg/ml, 5 mg/ml, 6 mg/ml, 7 mg/ml, 8 mg/ml, 9mg/ml, 10 mg/ml, 15 mg/ml, 20 mg/ml, 25 mg/ml, 30 mg/ml, 40 mg/ml, or 50mg/ml. In some embodiments, the concentration of the macrolide (e.g.,rapamycin) is no more than about any of 100 mg/ml, 90 mg/ml, 80 mg/ml,70 mg/ml, 60 mg/ml, 50 mg/ml, 40 mg/ml, 30 mg/ml, 20 mg/ml, 10 mg/ml, or5 mg/ml.

The volume of the nanoparticle composition per injection may vary withthe type of blood vessel for the injection, the purpose of the method,and the type of disease being treated. In some embodiments, the volumeper injection is about 0.01 to about 50 ml, including for example about0.01 to about 0.05 ml, about 0.05 to about 0.1 ml, about 0.1 to about0.5 ml, about 0.5 to about 1 ml, about 1 to about 2 ml, about 2 to about3 ml, about 3 to about 5 ml, about 5 to about 10 ml, about 10 to about20 ml, about 20 to about 30 ml, about 30 to about 40 ml, about 40 toabout 50 ml. In some embodiments, the volume per injection is about 0.05to about 2 ml, about 0.1 to 1 ml, about 0.25 to about 0.5 ml, or about0.5 to about 1 ml, or about 1 to about 5 ml.

Exemplary dosing frequencies for the administration of the nanoparticlecompositions include, but are not limited to, about once every 1, 2, 3,4, 5, 6, 7, 8, 9, 10, 11, or 12 months. In some embodiments, theintervals between each administration are more than about any of 1month, 2 months, 3 months, 4 months, 5 months, 6 months, 8 months, or 12months. In some embodiments, the administration is administered every 3,6, 9, 12, 15, 18, 21, or 24 months. In some embodiments, theadministration is administered at most every 3, 6, 9, 12, 15, 18, 21, or24 months. In some embodiments, the administration is administered atleast every 3, 6, 9, 12, 15, 18, 21, or 24 months. In some embodiments,the nanoparticle composition is injected only once.

The nanoparticle composition can be injected during a vascularinterventional procedure. In some embodiments, the nanoparticlecomposition is injected once during the vascular interventionalprocedure. In some embodiments, the nanoparticle composition is injectedafter a vascular interventional procedure. Exemplary vascularinterventional procedures include, but are not limited to, angioplasty,stenting, and atherectomy.

Nanoparticle Compositions

The nanoparticle compositions described herein comprise nanoparticlescomprising (in various embodiments consisting essentially of orconsisting of) a macrolide (such as rapamycin) and an albumin (such ashuman serum albumin). Nanoparticles of poorly water soluble drugs (suchas macrolide) have been disclosed in, for example, U.S. Pat. Nos.5,916,596; 6,506,405; 6,749,868, 6,537,579, 7,820,788, and also in U.S.Pat. Pub. Nos. 2006/0263434, and 2007/0082838; PCT Patent ApplicationWO08/137148, each of which is incorporated by reference in theirentirety.

In some embodiments, the composition comprises nanoparticles with anaverage or mean diameter of no greater than about 1000 nanometers (nm),such as no greater than about any of 900, 800, 700, 600, 500, 400, 300,200, and 100 nm. In some embodiments, the average or mean diameters ofthe nanoparticles is no greater than about 200 nm. In some embodiments,the average or mean diameters of the nanoparticles is no greater thanabout 150 nm. In some embodiments, the average or mean diameters of thenanoparticles is no greater than about 100 nm. In some embodiments, theaverage or mean diameter of the nanoparticles is about 20 to about 400nm. In some embodiments, the average or mean diameter of thenanoparticles is about 40 to about 200 nm. In some embodiments, theaverage or mean diameter of the nanoparticles is about 50 to about 100nm. In some embodiments, the nanoparticles are no less than about 50 nm.In some embodiments, the nanoparticles are sterile-filterable.

In some embodiments, the nanoparticles in the composition describedherein have an average diameter of no greater than about 200 nm,including for example no greater than about any one of 190, 180, 170,160, 150, 140, 130, 120, 110, 100, 90, 80, 70, or 60 nm. In someembodiments, at least about 50% (for example at least about any one of60%, 70%, 80%, 90%, 95%, or 99%) of the nanoparticles in the compositionhave a diameter of no greater than about 200 nm, including for exampleno greater than about any one of 190, 180, 170, 160, 150, 140, 130, 120,110, 100, 90, 80, 70, or 60 nm.

In some embodiments, the nanoparticles in the composition describedherein have an average diameter of no less than about 50 nm, includingfor example no less than about any one of 50, 60, 70, 80, 90, or 100 nm.In some embodiments, at least about 50% (for example at least about anyone of 60%, 70%, 80%, 90%, 95%, or 99%) of the nanoparticles in thecomposition have a diameter of no less than about 50 nm, including forexample no less than about any one of 50, 60, 70, 80, 90, or 100 nm.

In some embodiments, at least about 50% (for example at least any one of60%, 70%, 80%, 90%, 95%, or 99%) of the nanoparticles in the compositionfall within the range of about 20 to about 400 nm, including for exampleabout 20 to about 200 nm, about 40 to about 200 nm, about 30 to about180 nm, and any one of about 40 to about 150, about 50 to about 120, andabout 60 to about 100 nm.

In some embodiments, the albumin has sulfhydral groups that can formdisulfide bonds. In some embodiments, at least about 5% (including forexample at least about any one of 10%, 15%, 20%, 25%, 30%, 40%, 50%,60%, 70%, 80%, or 90%) of the albumin in the nanoparticle portion of thecomposition are crosslinked (for example crosslinked through one or moredisulfide bonds).

In some embodiments, the nanoparticles comprise the macrolide (such asrapamycin) coated with an albumin (e.g., human serum albumin). In someembodiments, the composition comprises a macrolide in both nanoparticleand non-nanoparticle forms (e.g., in the form of rapamycin solutions orin the form of soluble albumin/nanoparticle complexes), wherein at leastabout any one of 50%, 60%, 70%, 80%, 90%, 95%, or 99% of the macrolidein the composition are in nanoparticle form. In some embodiments, themacrolide in the nanoparticles constitutes more than about any one of50%, 60%, 70%, 80%, 90%, 95%, or 99% of the nanoparticles by weight. Insome embodiments, the nanoparticles have a non-polymeric matrix. In someembodiments, the nanoparticles comprise a core of a macrolide that issubstantially free of polymeric materials (such as polymeric matrix).

In some embodiments, the composition comprises albumin in bothnanoparticle and non-nanoparticle portions of the composition, whereinat least about any one of 50%, 60%, 70%, 80%, 90%, 95%, or 99% of thealbumin in the composition are in non-nanoparticle portion of thecomposition.

In some embodiments, the weight ratio of albumin (such as human serumalbumin) and a macrolide in the nanoparticle composition is about 18:1or less, such as about 15:1 or less, for example about 10:1 or less. Insome embodiments, the weight ratio of albumin (such as human serumalbumin) and macrolide in the composition falls within the range of anyone of about 1:1 to about 18:1, about 2:1 to about 15:1, about 3:1 toabout 13:1, about 4:1 to about 12:1, about 5:1 to about 10:1. In someembodiments, the weight ratio of albumin and macrolide in thenanoparticle portion of the composition is about any one of 1:2, 1:3,1:4, 1:5, 1:10, 1:15, or less. In some embodiments, the weight ratio ofthe albumin (such as human serum albumin) and the macrolide in thecomposition is any one of the following: about 1:1 to about 18:1, about1:1 to about 15:1, about 1:1 to about 12:1, about 1:1 to about 10:1,about 1:1 to about 9:1, about 1:1 to about 8:1, about 1:1 to about 7:1,about 1:1 to about 6:1, about 1:1 to about 5:1, about 1:1 to about 4:1,about 1:1 to about 3:1, about 1:1 to about 2:1, or about 1:1.

In some embodiments, the nanoparticle composition comprises one or moreof the above characteristics.

The nanoparticles described herein may be present in a dry formulation(such as lyophilized composition) or suspended in a biocompatiblemedium. Suitable biocompatible media include, but are not limited to,water, buffered aqueous media, saline, buffered saline, optionallybuffered solutions of amino acids, optionally buffered solutions ofproteins, optionally buffered solutions of sugars, optionally bufferedsolutions of vitamins, optionally buffered solutions of syntheticpolymers, lipid-containing emulsions, and the like.

In some embodiments, the pharmaceutically acceptable carrier compriseshuman serum albumin. Human serum albumin (HSA) is a highly solubleglobular protein of M_(r) 65K and consists of 585 amino acids. HSA isthe most abundant protein in the plasma and accounts for 70-80% of thecolloid osmotic pressure of human plasma. The amino acid sequence of HSAcontains a total of 17 disulphide bridges, one free thiol (Cys 34), anda single tryptophan (Trp 214). Intravenous use of HSA solution has beenindicated for the prevention and treatment of hypovolumic shock (see,e.g., Tullis, JAMA, 237, 355-360, 460-463, (1977)) and Houser et al.,Surgery, Gynecology and Obstetrics, 150, 811-816 (1980)) and inconjunction with exchange transfusion in the treatment of neonatalhyperbilirubinemia (see, e.g., Finlayson, Seminars in Thrombosis andHemostasis, 6, 85-120, (1980)). Other albumins are contemplated, such asbovine serum albumin. Use of such non-human albumins could beappropriate, for example, in the context of use of these compositions innon-human mammals, such as the veterinary (including domestic pets andagricultural context).

Human serum albumin (HSA) has multiple hydrophobic binding sites (atotal of eight for fatty acids, an endogenous ligand of HSA) and binds adiverse set of macrolides, especially neutral and negatively chargedhydrophobic compounds (Goodman et al., The Pharmacological Basis ofTherapeutics, 9^(th) ed, McGraw-Hill New York (1996)). Two high affinitybinding sites have been proposed in subdomains IIA and IIIA of HSA,which are highly elongated hydrophobic pockets with charged lysine andarginine residues near the surface which function as attachment pointsfor polar ligand features (see, e.g., Fehske et al., Biochem. Pharmcol.,30, 687-92 (198a), Vorum, Dan. Med. Bull., 46, 379-99 (1999),Kragh-Hansen, Dan. Med. Bull., 1441, 131-40 (1990), Curry et al., Nat.Struct. Biol., 5, 827-35 (1998), Sugio et al., Protein. Eng., 12, 439-46(1999), He et al., Nature, 358, 209-15 (199b), and Carter et al., Adv.Protein. Chem., 45, 153-203 (1994)). Rapamycin and propofol have beenshown to bind HSA (see, e.g., Paal et al., Eur. J. Biochem., 268(7),2187-91 (200a), Purcell et al., Biochim. Biophys. Acta, 1478(a), 61-8(2000), Altmayer et al., Arzneimittelforschung, 45, 1053-6 (1995), andGarrido et al., Rev. Esp. Anestestiol. Reanim., 41, 308-12 (1994)). Inaddition, docetaxel has been shown to bind to human plasma proteins(see, e.g., Urien et al., Invest. New Drugs, 14(b), 147-51 (1996)).

The albumin (such as human serum albumin) in the composition generallyserves as a carrier for the macrolide, i.e., the albumin in thecomposition makes the macrolide more readily suspendable in an aqueousmedium or helps maintain the suspension as compared to compositions notcomprising an albumin. This can avoid the use of toxic solvents (orsurfactants) for solubilizing the macrolide, and thereby can reduce oneor more side effects of administration of the macrolide into anindividual (such as a human). Thus, in some embodiments, the compositiondescribed herein is substantially free (such as free) of surfactants,such as Cremophor (including Cremophor EL® (BASF)). In some embodiments,the nanoparticle composition is substantially free (such as free) ofsurfactants. A composition is “substantially free of Cremophor” or“substantially free of surfactant” if the amount of Cremophor orsurfactant in the composition is not sufficient to cause one or moreside effect(s) in an individual when the nanoparticle composition isinjected to the individual. In some embodiments, the nanoparticlecomposition contains less than about any one of 20%, 15%, 10%, 7.5%, 5%,2.5%, or 1% organic solvent or surfactant.

The amount of albumin in the composition described herein will varydepending on other components in the composition. In some embodiments,the composition comprises an albumin in an amount that is sufficient tostabilize the macrolide in an aqueous suspension, for example, in theform of a stable colloidal suspension (such as a stable suspension ofnanoparticles). In some embodiments, the albumin is in an amount thatreduces the sedimentation rate of the macrolide in an aqueous medium.For particle-containing compositions, the amount of the albumin alsodepends on the size and density of nanoparticles of the macrolide.

A macrolide is “stabilized” in an aqueous suspension if it remainssuspended in an aqueous medium (such as without visible precipitation orsedimentation) for an extended period of time, such as for at leastabout any of 0.1, 0.2, 0.25, 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,24, 36, 48, 60, or 72 hours. The suspension is generally, but notnecessarily, suitable for administration to an individual (such ashuman). Stability of the suspension is generally (but not necessarily)evaluated at a storage temperature (such as room temperature (such as20-25° C.) or refrigerated conditions (such as 4° C.)). For example, asuspension is stable at a storage temperature if it exhibits noflocculation or particle agglomeration visible to the naked eye or whenviewed under the optical microscope at 1000 times, at about fifteenminutes after preparation of the suspension. Stability can also beevaluated under accelerated testing conditions, such as at a temperaturethat is higher than about 40° C.

In some embodiments, the albumin is present in an amount that issufficient to stabilize the macrolide in an aqueous suspension at acertain concentration. For example, the concentration of the macrolidein the composition is about 0.1 to about 100 mg/ml, including forexample any of about 0.1 to about 50 mg/ml, about 0.1 to about 20 mg/ml,about 1 to about 10 mg/ml, about 2 mg/ml to about 8 mg/ml, about 4 toabout 6 mg/ml, about 5 mg/ml. In some embodiments, the concentration ofthe macrolide is at least about any of 1.3 mg/ml, 1.5 mg/ml, 2 mg/ml, 3mg/ml, 4 mg/ml, 5 mg/ml, 6 mg/ml, 7 mg/ml, 8 mg/ml, 9 mg/ml, 10 mg/ml,15 mg/ml, 20 mg/ml, 25 mg/ml, 30 mg/ml, 40 mg/ml, and 50 mg/ml. In someembodiments, the albumin is present in an amount that avoids use ofsurfactants (such as Cremophor), so that the composition is free orsubstantially free of surfactant (such as Cremophor).

In some embodiments, the composition, in liquid form, comprises fromabout 0.1% to about 50% (w/v) (e.g. about 0.5% (w/v), about 5% (w/v),about 10% (w/v), about 15% (w/v), about 20% (w/v), about 30% (w/v),about 40% (w/v), or about 50% (w/v)) of albumin. In some embodiments,the composition, in liquid form, comprises about 0.5% to about 5% (w/v)of albumin.

In some embodiments, the weight ratio of albumin, e.g., albumin, to themacrolide in the nanoparticle composition is such that a sufficientamount of macrolide binds to, or is transported by, the cell. While theweight ratio of albumin to macrolide will have to be optimized fordifferent albumin and macrolide combinations, generally the weight ratioof albumin, e.g., albumin, to macrolide (w/w) is about 0.01:1 to about100:1, about 0.02:1 to about 50:1, about 0.05:1 to about 20:1, about0.1:1 to about 20:1, about 1:1 to about 18:1, about 2:1 to about 15:1,about 3:1 to about 12:1, about 4:1 to about 10:1, about 5:1 to about9:1, or about 9:1. In some embodiments, the albumin to macrolide weightratio is about any of 18:1 or less, 15:1 or less, 14:1 or less, 13:1 orless, 12:1 or less, 11:1 or less, 10:1 or less, 9:1 or less, 8:1 orless, 7:1 or less, 6:1 or less, 5:1 or less, 4:1 or less, and 3:1 orless. In some embodiments, the weight ratio of the albumin (such ashuman serum albumin) to the macrolide in the composition is any one ofthe following: about 1:1 to about 18:1, about 1:1 to about 15:1, about1:1 to about 12:1, about 1:1 to about 10:1, about 1:1 to about 9:1,about 1:1 to about 8:1, about 1:1 to about 7:1, about 1:1 to about 6:1,about 1:1 to about 5:1, about 1:1 to about 4:1, about 1:1 to about 3:1,about 1:1 to about 2:1, or about 1:1.

In some embodiments, the albumin allows the composition to be injectedto an individual (such as human) without significant side effects. Insome embodiments, the albumin (such as human serum albumin) is in anamount that is effective to reduce one or more side effects ofadministration of the macrolide to a human. The term “reducing one ormore side effects of administration of the macrolide” refers toreduction, alleviation, elimination, or avoidance of one or moreundesirable effects caused by the macrolide, as well as side effectscaused by delivery vehicles (such as solvents that render the macrolidessuitable for injection) used to deliver the macrolide. Such side effectsinclude, for example, myelosuppression, neurotoxicity, hypersensitivity,inflammation, venous irritation, phlebitis, pain, skin irritation,peripheral neuropathy, neutropenic fever, anaphylactic reaction, venousthrombosis, extravasation, and combinations thereof. These side effects,however, are merely exemplary and other side effects, or combination ofside effects, associated with macrolides can be reduced.

In some embodiments, the nanoparticle composition comprisesNab-rapamycin (Celgene Corp.). In some embodiments, the nanoparticlecomposition is Nab-rapamycin. Nab-rapamycin is a formulation ofrapamycin stabilized by human albumin USP, which can be dispersed indirectly injectable physiological solution. When dispersed in a suitableaqueous medium such as 0.9% sodium chloride injection or 5% dextroseinjection, Nab-rapamycin forms a stable colloidal suspension ofrapamycin. The mean particle size of the nanoparticles in the colloidalsuspension is about 90 nanometers. Since HSA is freely soluble in water,Nab-rapamycin can be reconstituted in a wide range of concentrationsranging from dilute (0.1 mg/ml rapamycin) to concentrated (20 mg/mlrapamycin), including for example about 2 mg/ml to about 8 mg/ml, orabout 5 mg/ml.

Methods of making nanoparticle compositions are known in the art. Forexample, nanoparticles containing macrolides (such as rapamycin) andalbumin (such as human serum albumin) can be prepared under conditionsof high shear forces (e.g., sonication, high pressure homogenization, orthe like). These methods are disclosed in, for example, U.S. Pat. Nos.5,916,596; 6,506,405; 6,749,868, 6,537,579 and 7,820,788 and also inU.S. Pat. Pub. Nos. 2007/0082838, 2006/0263434 and PCT ApplicationWO08/137148.

Briefly, the macrolide (such as rapamycin) is dissolved in an organicsolvent, and the solution can be added to an albumin solution. Themixture is subjected to high pressure homogenization. The organicsolvent can then be removed by evaporation. The dispersion obtained canbe further lyophilized. Suitable organic solvent include, for example,ketones, esters, ethers, chlorinated solvents, and other solvents knownin the art. For example, the organic solvent can be methylene chlorideor chloroform/ethanol (for example with a ratio of 1:9, 1:8, 1:7, 1:6,1:5, 1:4, 1:3, 1:2, 1:1, 2:1, 3:1, 4:1, 5:1, 6:1, 7:1, 8:1, or 9:1).

Other Components in the Nanoparticle Compositions

The nanoparticles described herein can be present in a composition thatinclude other agents, excipients, or stabilizers. For example, toincrease stability by increasing the negative zeta potential ofnanoparticles, one or more of negatively charged components may beadded. Such negatively charged components include, but are not limitedto bile salts of bile acids consisting of glycocholic acid, cholic acid,chenodeoxycholic acid, taurocholic acid, glycochenodeoxycholic acid,taurochenodeoxycholic acid, litocholic acid, ursodeoxycholic acid,dehydrocholic acid and others; phospholipids including lecithin (eggyolk) based phospholipids which include the followingphosphatidylcholines: palmitoyloleoylphosphatidylcholine,palmitoyllinoleoylphosphatidylcholine,stearoyllinoleoylphosphatidylcholine stearoyloleoylphosphatidylcholine,stearoylarachidoylphosphatidylcholine, anddipalmitoylphosphatidylcholine. Other phospholipids including L-α-dimyristoylphosphatidylcholine (DMPC), dioleoylphosphatidylcholine (DOPC), distearyolphosphatidylcholine (DSPC), hydrogenated soy phosphatidylcholine(HSPC), and other related compounds. Negatively charged surfactants oremulsifiers are also suitable as additives, e.g., sodium cholesterylsulfate and the like.

In some embodiments, the composition is suitable for administration to ahuman. In some embodiments, the composition is suitable foradministration to a mammal such as, in the veterinary context, domesticpets and agricultural animals. There are a wide variety of suitableformulations of the nanoparticle composition (see, e.g., U.S. Pat. Nos.5,916,596, 6,096,331, and 7,820,788). The following formulations andmethods are merely exemplary and are in no way limiting. Formulationssuitable for oral administration can consist of (a) liquid solutions,such as an effective amount of the compound dissolved in diluents, suchas water, saline, or orange juice, (b) capsules, sachets or tablets,each containing a predetermined amount of the active ingredient, assolids or granules, (c) suspensions in an appropriate liquid, and (d)suitable emulsions. Tablet forms can include one or more of lactose,mannitol, corn starch, potato starch, microcrystalline cellulose,acacia, gelatin, colloidal silicon dioxide, croscarmellose sodium, talc,magnesium stearate, stearic acid, and other excipients, colorants,diluents, buffering agents, moistening agents, preservatives, flavoringagents, and pharmacologically compatible excipients. Lozenge forms cancomprise the active ingredient in a flavor, usually sucrose and acaciaor tragacanth, as well as pastilles comprising the active ingredient inan inert base, such as gelatin and glycerin, or sucrose and acacia,emulsions, gels, and the like containing, in addition to the activeingredient, such excipients as are known in the art.

Examples of suitable carriers, excipients, and diluents include, but arenot limited to, lactose, dextrose, sucrose, sorbitol, mannitol,starches, gum acacia, calcium phosphate, alginates, tragacanth, gelatin,calcium silicate, microcrystalline cellulose, polyvinylpyrrolidone,cellulose, water, saline solution, syrup, methylcellulose, methyl- andpropylhydroxybenzoates, talc, magnesium stearate, and mineral oil. Theformulations can additionally include lubricating agents, wettingagents, emulsifying and suspending agents, preserving agents, sweeteningagents or flavoring agents.

Formulations suitable for parenteral administration such as injectioninclude aqueous and non-aqueous, isotonic sterile injection solutions,which can contain anti-oxidants, buffers, bacteriostats, and solutesthat render the formulation compatible with the blood of the intendedrecipient, and aqueous and non-aqueous sterile suspensions that caninclude suspending agents, solubilizers, thickening agents, stabilizers,and preservatives. The formulations can be presented in unit-dose ormulti-dose sealed containers, such as ampules and vials, and can bestored in a freeze-dried (lyophilized) condition requiring only theaddition of the sterile liquid excipient, for example, water, forinjections, immediately prior to use. Extemporaneous injection solutionsand suspensions can be prepared from sterile powders, granules, andtablets of the kind previously described. Injectable formulations arepreferred.

In some embodiments, the composition is formulated to have a pH range ofabout 4.5 to about 9.0, including for example pH ranges of any of about5.0 to about 8.0, about 6.5 to about 7.5, and about 6.5 to about 7.0. Insome embodiments, the pH of the composition is formulated to no lessthan about 6, including for example no less than about any of 6.5, 7, or8 (such as about 8). The composition can also be made to be isotonicwith blood by the addition of a suitable tonicity modifier, such asglycerol.

Kits and Devices

The invention also provides kits and devices for use in any of themethods described herein.

For example, in some embodiments, there is provided a catheter with aneedle (such as a deployable needle), wherein the needle contains acomposition comprising nanoparticle comprising a macrolide (such asrapamycin) and an albumin. In some embodiments, there is provided acatheter with a needle (such as a deployable needle), wherein the needlecontains a composition comprising nanoparticle comprising a macrolide(such as rapamycin) coated with an albumin. In some embodiments, thereis provided a catheter with a needle (such as a deployable needle),wherein the needle contains a composition comprising nanoparticlecomprising a macrolide (such as rapamycin) and an albumin, wherein theaverage particle size of the nanoparticles in the composition is nogreater than about 200 nm (such as less than about 200 nm, for exampleno greater than about 100 nm). In some embodiments, there is provided acatheter with a needle (such as a deployable needle), wherein the needlecontains a composition comprising nanoparticle comprising a macrolide(such as rapamycin) coated with an albumin, wherein the average particlesize of the nanoparticles in the composition is no greater than about200 nm (such as less than about 200 nm, for example no greater thanabout 100 nm). In some embodiments, there is provided a catheter with aneedle (such as a deployable needle), wherein the needle containsNab-rapamycin. In some embodiments, the needle is sheathed in a balloon.In some embodiments the diameter of the needle is about 0.1 to about 3mm, including for example about 0.2 to about 2 mm, about 0.5 to about 1mm, about 0.6 to about 0.9 mm, or about 0.9 mm. The length of the needleis typically between about 20 and 3000 microns, including for examplebetween about 20-50, about 50-100, about 100-200, about 200-300, about300-400, about 400-500, about 500-600, about 600-700, about 700-800,about 800-900, about 1-2, and about 2-3 microns. In some embodiments,the catheter contains more than 1 (such as 2, 3, 4, 5, 6, 7, or more)needles.

Also provided are kits comprising one or more containers comprisingmacrolide-containing nanoparticle compositions (or unit dosage formsand/or articles of manufacture) and in some embodiments, furthercomprise instructions for use in accordance with any of the methodsdescribed herein. In some embodiments, the kit comprises a catheterhaving a needle which can be advanced from a blood vessel lumen througha wall of the blood vessel (for example to position an aperture of theneedle beyond an external elastic lamina of the wall), and ananoparticle composition comprising a macrolide and albumin, wherein thenanoparticle composition is injectable through the needle. In someembodiments, the kit further comprises a syringe. In some embodiments,the syringe is filled up with an effective amount of the nanoparticlecomposition.

The kit may further comprise a description of selection of individualsuitable for treatment. Instructions supplied in the kits of theinvention are typically written instructions on a label or packageinsert (e.g., a paper sheet included in the kit), but machine-readableinstructions (e.g., instructions carried on a magnetic or opticalstorage disk) are also acceptable.

The kits of the invention are in suitable packaging. Suitable packaginginclude, but is not limited to, vials, bottles, jars, flexible packaging(e.g., sealed Mylar or plastic bags), and the like. Kits may optionallyprovide additional components such as buffers and interpretativeinformation. The present application thus also provides articles ofmanufacture, which include vials (such as sealed vials), bottles, jars,flexible packaging, and the like.

The instructions relating to the use of the nanoparticle compositionsgenerally include information as to dosage, dosing schedule, andspecific instructions on delivering the nanoparticle composition. Thecontainers may be unit doses, bulk packages (e.g., multi-dose packages)or sub-unit doses. Kits may also include multiple unit doses of themacrolide and pharmaceutical compositions and instructions for use andpackaged in quantities sufficient for storage and use in pharmacies, forexample, hospital pharmacies and compounding pharmacies.

Those skilled in the art will recognize that several embodiments arepossible within the scope and spirit of this invention. The inventionwill now be described in greater detail by reference to the followingnon-limiting examples. The following examples further illustrate theinvention but, of course, should not be construed as in any way limitingits scope.

EXAMPLES Example 1. Method for Periadventitial Injection withMicro-Infusion Catheter

This example demonstrates the injection of Nab-rapamycin into theperiadventitial tissue. Nab-rapamycin (Celgene Corporation) wasreconstituted in saline to 5 mg/ml prior to the injection.

To inject Nab-rapamycin into the periadventitial tissue, the Bullfrog®Micro-Infusion Catheter (Mercator Medsystems, San Leandro Calif.) wasintroduced into the artery while deflated and with the 0.9 mm needlesheathed within a balloon (FIG. 1A). When the balloon was inflated, theneedle extruded outward, perpendicular to the axis of the catheter whilea backing balloon provided an opposing force to slide the needle intothe artery wall (FIG. 1B). Nab-rapamycin was then delivered into theperiadventitial tissue through the needle.

Example 2. Periadventitial Delivery of Nab-Rapamycin in a PorcineFemoral Artery Balloon Injury Model

This experiment was conducted to determine whether periadventitialdelivery of Nab-rapamycin can decrease luminal stenosis in a porcinefemoral artery balloon angioplasty injury model.

Sixteen juvenile male Yorkshire cross pigs (average weight 34.9±2.3 kg)were used in 2 study arms (FIGS. 2A and 2B). After induction of generalanesthesia, percutaneous access was obtained via the carotid artery.Animals were given intravenous heparin (5000 units). All pigs weremaintained on aspirin 81 mg daily after the procedure. Femoral arterieswere flushed with 1 liter lactated Ringer's solution after sacrifice.Arteries were then harvested (pharmacokinetics arm) or subsequentlyperfusion fixed at 120 mmHg for 10 minutes with 10% buffered formalinbefore harvest (histopathology arm).

Nab-rapamycin was injected by periadventitial injection. An initialdiagnostic angiogram showed the target femoral artery diameter was 4 mm(FIG. 3A). The micro-infusion catheter was positioned in the mid-femoralartery and the balloon was inflated (FIG. 3B). A periadventitialinjection of Nab-rapamycin solution with 20% iodinated contrast (IsoVue370) showed circumferential coverage of the vessel (FIGS. 3C-3E).Completion angiogram revealed a patent femoral artery (FIG. 3F). Therewas 100% procedural success with 32 injection sites. Average injectiontime was 90 seconds (1 ml/min). There were no dissections, early or latethromboses, hemorrhages or arteriovenous fistulas.

Histomorphometry results after periadventitial injection ofNab-rapamycin in the femoral artery were analyzed. Femoral arteriestreated with periadventitial Nab-rapamycin had significantly largerlumen cross-sectional areas p=0.01 (ANOVA)(FIG. 4A), as well assignificantly larger total vessel cross-sectional areas (FIG. 4B),p=0.005 (ANOVA) at 28 days after treatment. There was a trend towarddecreasing percent luminal stenosis with Nab-rapamycin treatment at 28days. Femoral arteries treated with periadventitial Nab-rapamycin (500 □g) had a 42% reduction in luminal stenosis at 28 days (19.5+3% vs11.4+0.8%, p=0.01 t-test) (FIG. 4C). The average medial fibrosis scoreat 28 days was significantly less in the Nab-rapamycin treated arteriescompared to control arteries treated with vehicle alone (FIG. 4D),p<0.0001 (ANOVA).

Pharmacokinetic results after periadventitial injection of Nab-rapamycinin the femoral artery were analyzed. Blood (serum) rapamycin levels rosein the first hour after a single periadventitial injection ofNab-rapamycin at 500 μg, but fell by 1 day and were not detectable by 28days (FIG. 5A). In the femoral artery and surrounding perivasculartissue, the rapamycin concentration was over 1500-times the serumconcentration at 1 hour. Rapamycin persisted over 8 days and was notdetectable by 28 days (FIG. 5B).

Histopathology results after periadventitial injection of Nab-rapamycinin the femoral artery were analyzed. FIGS. 6A-6D show representativesections of femoral arteries 28 days after treatment with vehicle (FIGS.6A and 6B) or Nab-rapamycin 500 μg (FIGS. 6C and 6D). Nab-rapamycintreatment was associated with significantly reduced medial fibrosis withsimilar degrees of internal elastic lamina injury (inset, 100×). Vesselswere stained with H&E (FIGS. 6A and 6C) and trichrome (FIGS. 6B and 6D)and imaged at 25×.

Further histomorphometry analyses showed that Nab-rapamycin treatmentwas associated with significantly reduced proliferation index (FIG. 7A).On the other hand, there was no difference in endothelialization at 28days in control and Nab-rapamycin treated femoral arteries (FIG. 7B).

Further pharmacokinetics analyses showed that the proliferation indexfell significantly between 3 and 28 days in balloon-injured arteriestreated with 500 μg Nab-rapamycin, p=0.004 (ANOVA)(FIG. 8A).Re-endotheolialization occurred by 8 days (FIG. 8B).

Additionally, at 3 days, there were significantly fewer adventitialleukocytes in arteries treated with periadventitial Nab-rapamycin (FIG.9A). By 28 days, Nab-rapamycin treated arteries had significantly feweradventitial vessels (FIG. 9B).

The results reported herein demonstrate that periadventitial delivery ofNab-rapamycin is associated with a transient increase and rapid fall inserum rapamycin levels. At 1 hour after treatment, rapamycin levels inthe perivascular tissue were over 1500 times those in the blood andrapamycin was retained in the perivascular tissue for at least 8 days(FIG. 5B). Balloon injured femoral arteries treated with Nab-rapamycinwere significantly larger than vehicle treated arteries, suggesting lessnegative remodeling. Furthermore, periadventitial delivery ofNab-rapamycin leads to significant decrease in medial fibrosis.

Nab-rapamycin treated arteries demonstrated significantly less early (3day) adventitial leukocyte infiltration. The Ki-67 proliferation indexof Nab-rapamycin treated arteries was significantly lower at 28 days(FIG. 8A).

There was no difference in endothelialization at 28 days in control andNab-rapamycin treated femoral arteries, and re-endothelialization toballoon-injured Nab-rapamycin treated vessels appeared to occur in thefirst week and appeared to complete by 8 days (FIG. 10). Nab-rapamycintreatment leads to a significantly lower proliferation and significantlylower medial fibrosis scores, suggesting a mechanism by which rapamycinmay affect remodeling in balloon-injured femoral arteries.

A decrease in early adventitial leukocyte infiltration and subsequentreduction in medial fibrosis and Ki-67 proliferation index at 28 dayssuggests a mechanism by which periadventitial Nab-rapamycin may have aneffect.

Although the foregoing invention has been described in some detail byway of illustration and example for purposes of clarity ofunderstanding, it is apparent to those skilled in the art that certainminor changes and modifications will be practiced. Therefore, thedescription and examples should not be construed as limiting the scopeof the invention.

What is claimed is:
 1. A method of inhibiting negative remodeling in ablood vessel in an individual in need thereof, comprising injecting intothe blood vessel wall or tissue surrounding the blood vessel wall aneffective amount of a composition comprising nanoparticles comprising amacrolide and an albumin.
 2. A method of delivering a compositioncomprising nanoparticles comprising albumin and a macrolide to a bloodvessel, wherein the method comprises injecting into the blood vesselwall or tissue surrounding the blood vessel wall an effective amount ofa composition comprising nanoparticles comprising a macrolide and analbumin.
 3. The method of claim 2, wherein the blood vessel is anartery.
 4. The method of claim 2, wherein the blood vessel is a vein. 5.The method of claim 2, wherein the nanoparticle composition is injectedinto the blood vessel wall.
 6. The method of claim 2, wherein thenanoparticle composition is injected into the tissue surrounding theblood vessel wall.
 7. The method of claim 2, wherein the nanoparticlecomposition is injected at a dose of about 0.001 mg to about 100 mg. 8.The method of claim 2, wherein the injection volume of the nanoparticlecomposition is about 0.01 ml to about 50 ml.
 9. The method of claim 2,wherein the nanoparticle composition is injected though a catheter witha needle.
 10. The method of claim 2, wherein the nanoparticlecomposition is injected at least once a year.
 11. The method of claim 2,wherein the nanoparticle composition is injected distal or proximal tothe disease site.
 12. The method of claim 2, wherein the nanoparticlecomposition is injected at least about 2 cm away from the disease site.13. The method of claim 2, wherein the nanoparticle composition isinjected at or adjacent to the disease site.
 14. The method of claim 2,wherein the individual has any one of: angina, myocardial infarction,congestive heart failure, cardiac arrhythmia, peripheral artery disease,claudication, or chronic limb ischemia.
 15. A catheter with a needle,wherein the needle contains a composition comprising nanoparticlescomprising a macrolide and an albumin.